Imagine you’re in the final stages of terminal cancer. You’ve reached a point where treatment is no longer effective. Where would you want to spend your final days or weeks?

Many people would prefer to be at home, close to family and friends, while receiving palliative or hospice care. But, depending on where you live, this might be an unlikely scenario. If you live in Manhattan, for example, your last days may well be spent in the hospital, undergoing aggressive medical procedures.

The Dartmouth Atlas Project has released a new report that brings to light the stark differences in end-of-life care that cancer patients are likely to receive, based on where they live. The report looked at the records of Medicare patients with aggressive or metastatic cancer who died between 2003 and 2007. Highlights include:

• Nationwide, 29% of patients died in a hospital.

• Patients who were treated in Manhattan were the most likely to die in a hospital. This is where nearly half of Manhattan patients passed away.

• In Mason City, Iowa, on the other hand, only 7% of patients died in a hospital.

• In Huntsville, Alabama, more than 40% of the patients studied were admitted to the Intensive Care Unit during their last month of life – and they stayed there up to 25 times longer than patients in other regions.

Where you live is also a determining factor in the type of treatment you receive, with chemotherapy and other aggressive treatments like intubation and repeated resuscitations often figuring prominently in the end-of-life experiences of patients in places like Manhattan and Los Angeles.

So, what can we – and our clients – do if we want to stay clear of hospitals and invasive medical procedures during the final stages of a terminal illness? We have to be proactive.

First, be sure there’s an advance directive in place, making it clear to doctors that their focus needs to be on quality of life, rather than on prolonging life at all costs. Medical staff may not bring up the availability of hospice or palliative care, so if you prefer this option, your preference needs to be in writing.

It’s also important to have a healthcare power of attorney, with a carefully-chosen agent. The agent needs to have a clear understanding of the client’s expectations and preferences when it comes to end-of-life care. And, he or she needs to be the type of person who can communicate well with medical personnel, and make a stand for the client’s preferences over hospital protocol, if the need arises.

As estate planning attorneys, we deal with many complicated issues. But, sometimes the most important things we do for our clients are the most basic: Advance Directives and Health Care Powers of Attorney.

Stephen C. Hartnett, J.D., LL.M.
Associate Director of Education
American Academy of Estate Planning Attorneys, Inc.
6050 Santo Rd., Ste. 240
San Diego, CA 92124
(800) 846-1555
www.aaepa.com